Question

Can U=U apply before 6 months?

8 May 2024. Related: Adherence, All topics, CD4 and viral load, HIV transmission.

Good morning, I tested positive in February. I started the treatment at the same day with Biktarvy. I was undetectable within 20 days of treatment and another test undetectable in April. I never missed a dose or took in a different time. If I have unprotected sex with someone negative would the person need to get PEP?

I’m confused as they say you are considered U=U after being undetectable for 6 months, would I be at risk of infecting someone after being undetectable for 2 months?

Answer

Answer: Josh Peasegood

Hi, how are you doing?

It is great to hear how well you have done on treatment. No your partner will not require PEP.

6 months is a guideline recommended to confirm robust suppression of viral load. It is a length of time that has been suggested to show that treatment is working and HIV is being suppressed.

Most people achieve undetectable viral loads before this (as you have) and can rely on being undetectable sooner. Having 2 consecutive suppressed viral loads shows that you are ‘robustly’ suppressed. There is no worry that your viral load will rebound and you are able to rely on U=U.

As mentioned in the U=U guide, 6 months is a cautious guide and it is more important to be on a stable regimen rather than a certain length of time. The fact you have missed no doses is a better factor to rely on, instead of a length of time. You have also had a second test to confirm how well you are doing on treatment.

Please see this previous question for information about studies that have lead to U=U.

Josh.